An Interview with Stephen Sinatra, M.D.
KIRK HAMILTON: Hi, my name is Kirk Hamilton, your host of Staying Healthy Today, and our mission is simple: To provide you credible usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.
Today's show topic is "Heart Disease Prevention And Reversal With The New Cardiology." Our guest today is Dr. Stephen Sinatra, M.D., a board certified cardiologist, certified bioenergetic psychotherapist and is certified as a nutrition and anti-aging specialist. Dr. Sinatra has written numerous books including "Lower Your Blood Pressure In Eight Weeks," "The Sinatra Solution: Metabolic Cardiology," his newest book, "Earthing: The Most Important Health Disovery Ever?" and "Reverse Heart Disease Now," which is the topic for today's show. Dr. Sinatra is also author of the nationally distributed newsletter "Heart, Health and Nutrition."
Welcome, Dr. Sinatra. Thank you so much for taking time out of your busy day to be on the show with us.
DR. STEPHEN SINATRA: Hey, it's great to be here, Kirk.
KIRK HAMILTON: Heart disease is the number one killer still worldwide. We have not only epidemics in the United States but now we have industrialized nations and developing countries and economies all over the world, Asia developing heart disease, Japan is getting heart disease, and India in fact has one of the highest rates of heart disease in the world. So it's obviously a very important topic. And I was wondering if you could tell us how you got into being open to other ways of looking at cardiovascular disease.
DR. STEPHEN SINATRA: Sure. I mean what you said is absolutely true. I mean a lot of these Asian countries are getting heart disease probable due to more air pollution, cigarette smoking and more emotional stress which are big factors in heart disease. But in my sort of journey of being a cardiologist, I just became aware of so many different modalities in the essence of heart disease. And if you look at all the risk factors for heart disease, basically all the Framingham risk factors, whether it's high cholesterol or low HDL or high blood sugar or hypertension or high blood sugar or uric acid in the blood, they all signify inflammation. So inflammation is really at the root cause of heart disease. And if you can believe that, what you really realize is that when you're inflamed your blood thickens. So the thicker your blood, the more hypercoagulable your blood is. The more likely your blood is like red ketchup, the higher your incidence of heart disease, and everything from emotional stress, to low HDL, to high blood sugar contribute to a thickened blood situation. So I'm looking at heart disease more from what's in our pipes. In other words, what's in the blood or looking at the Zeta potential, or really the blood viscosity of the person.
KIRK HAMILTON: When you go and look on CDC websites and things, there's cardiovascular disease and heart disease and sometimes it gets confusing. Can you tell us the difference in your definition between the two?
DR. STEPHEN SINATRA: Yes. I mean basically they're the same. But if people are talking about coronary artery disease, that can come under the title of cardiovascular or heart disease. I mean you can have heart muscle disease, where you can have normal coronaries but you know you'll have what we call cardiomyopathy. It could be from alcoholism or infection or longstanding valvular disease. So cardiovascular disease and heart disease can be sort of the same. But once you talk about coronary artery disease then you have a specific etiology of a specific cause. So I know it's a little bit confusing, but I like the term cardiovascular disease.
KIRK HAMILTON: So let's talk about what causes injury to the vessel. You mentioned inflammation. I know it's complicated because I've tried to go through it myself and sometimes I get confused. But what inflames the artery?
DR. STEPHEN SINATRA: Yes, I mean I refer to it like the "dirty dozen" in my book "Reverse Heart Disease Now." I did a whole chapter on this. But clearly the most single entity that I believe that causes relentless inflammation is oxidative stress and I think sugar and insulin, you know over production of insulin. Insulin is very endothelial cell unfriendly, and sugar which is really in our diet in the form of high fructose corn syrup, and people are drinking loads of sodas today and eating terrible foods with a high glycemic index, so clearly the more insulin you produce in your body the more inflammation occurs. So I'm a big proponent of following a diet that's low in sugar. I happen to believe, I mean I don't believe in the cholesterol theory of heart disease. I believe in the sugar theory of heart disease, so sugar, trans fats, radiation, heavy metals, insecticides, pesticides, they all cause oxidative stress. And I'll tell you Kirk next to sugar, the leading cause of oxidative stress in our body is the wireless technologies, and you know the cellular phones, the cordless phones, the computers, the cell phone towers. You know all these chaotic energies that we can't see or feel, are causing awful oxidative stress in our bodies and they're causing what we call endothelial cell dysfunction and inflammation in our blood vessels.
KIRK HAMILTON: It's funny because I was coming, as I was driving in and thinking this morning, you know I tend to be a plant-based guy, a very low-fat kind of guy, and I look for studies that have shown that plant-based diets can reverse heart disease in some areas and then obviously you see cultures that eat animal food and fish and - but the common denominator of both of those ends of the spectrum, whether you eat some animal foods and high unrefined diet, or a plant-based diet solely, the common denominator is the low glycemic foods in all these indigenous cultures, whether it's the Tarahumara Indians who eat just plants or you take the Greeks who might add lots of olive oil and some fish or something like that. But all those diets are low glycemic diets in their purest form and therefore by what you just said would help reduce inflammation. Am I kind of putting it together?
DR. STEPHEN SINATRA: Oh, you're putting it together. And if you look at, I mean remember years ago the bad rap that saturated fat got? I mean a lot of this came out of the McGovern situation, you know, and Eisenhower and like 30 or 40 years ago when saturated fat was blamed for heart disease. I mean look at the most productive or the most healing saturated fat of all time. I mean look at these Asian cultures who eat coconuts and are getting monolaurin and getting the saturated fat in coconuts. I mean a coconut diet is one of the healthiest diets you can possibly eat. So yeah I agree with you. I mean these cultures that have a healthy fat and maybe healthy proteins or lower amounts of animal protein and plant-based foods are really doing themselves a lot of good. It's when it come down to it, it's sugar. And if you look at the industrialization of sugar, I mean my gosh the high fructose corn syrups and now there's mercury being implicated, you know even the synthetic sugars, the aspartames and all those sugars cause insulin responses. So it boils down to sugar in my mind as one of the biggest reasons why we see a lot of inflammation in the body.
KIRK HAMILTON: So let me get this two cents in here because again I come back to my plant-based roots, so to speak. But most of the antioxidant compounds generally come from plant foods. So if you have low glycemic across the board whether you eat animal food or not, wouldn't you want to get more phyto-rich entities that are protective against oxidative stress and aren't most of those in plant foods?
DR. STEPHEN SINATRA: Sure. I mean again, plant-based diet is going to give you all the polyphenols you need, the bioflavonoids, certainly the carotenoids. So yes you're correct. But remember the big three in the animal kingdom would be coenzyme Q10, carnitine and alpha lipoic acid. So a pure vegetarian needs to supplement with ALA, Co-Q10 and L-carnitine because you won't find them in substantial quantities in the plant kingdom. So you know the type of diet I practice, I practice an 80% plant diet myself and about a 20% or 15% animal based diet, because I want to make sure I get in Co-Q10 , carnitine and ALA in the diet and I also take them as supplements as well.
KIRK HAMILTON: So list some of your "Dirty Dozen." I'm assuming these are the entities that increase inflammation. Can we go through some of those?
DR. STEPHEN SINATRA: Sure. Sugar, trans fats are probably the worst because they're like unguided missiles and cause unrelentless oxidative stress. Insecticides and pesticides for example, we know now that insecticides and pesticides are the main cause of Parkinson's disease because they penetrate what we call the substantia nigra of the brain and we can't produce dopamine. Radiation is awesome in causing oxidative stress. We know that survivors of Chernobyl, or even in our country here, Three Mile Island, we saw a lot of thyroid cancers and we see the highest oxidized LDLs in children exposed to radiation. Now it's the wireless, and my biggest concern right now is the wireless technologies and these chaotic vibrations, the microwave technologies are causing hypercoagulable blood in the body, and it's my feeling that this is going to be the biggest health dilemma that we are going to be seeing in the near future. And let us not forget the chemical toxicity in environment and what's going on in the Gulf right now with this oil spill is horrendous. I mean people in the United States even where I - I'm speaking to you from Connecticut - people from Connecticut have to get concerned just like people from Louisiana because it's going to affect all of us. And so I really believe that the chemically polluted environment, the electrically polluted environment, is going to have a big, create a big surge in illness in the country because of inflammation being the culprit induced by these toxic entities.
KIRK HAMILTON: Well let's stay with - I want to stay with cholesterol for a second because I want to know your - on one side you say you know you're not as concerned about cholesterol and yet I know you have cholesterol-lowering products. So how do you put those two together?
DR. STEPHEN SINATRA: Well you know I'm not that concerned about cholesterol. I am concerned about Lp(a). Now Lp(a) is a small cholesterol particle and has a disulfide bridge. I feel like that's the real cholesterol story, but there's very few pharma - there's really no pharmaceuticals other than maybe Niaspan that can really lower Lp(a). I mean I lower Lp(a) with nattokinase, I use lumbrokinase, I use delta tocotrienol, certainly niacin helps, fish oil helps to neutralize Lp(a), but Lp(a) is a really, really inflammatory and it's a prothrombotic particle and I am very concerned about in my patient population. Now small cholesterol particles - so if you do a VAP test or an LPP, lipoprotein profile, where you dissect the LDL particle, if you have a lot of small particles and pro-inflammatory particles, then I get a little more excited about cholesterol being found at the crime of heart disease. See the problem in our country is basically the media feels that cholesterol is the cause of heart disease. It's found at the scene of the crime but it's not the perpetrator. There's far more entities that are more toxic to the endothelial lining of the blood vessels other than cholesterol. Remember the MRFIT Study where in that study of over 300,000 men over a 15 year period, men with the highest cholesterols over 330 had less hemorrhagic stroke than men with less cholesterols of less than 180. So I mean cholesterol does do some good to the body. We've created a huge myth and unfortunately a big lie about cholesterol. There's lots of harmless cholesterols that do the body a lot of good, but yet we're focused on cholesterol as the enemy. Sugar is the enemy, Kirk, not cholesterol.
KIRK HAMILTON: Okay. I got the glycemic part there. So let me ask you this then. I put in there the Castelli quote. You know basically he said that he didn't, in the Framingham study and I've taken the quote right from him, that cholesterols below 150, total cholesterols, he didn't see heart attacks. Now I read some of your work and you said yes you do. So if you naturally, with just eating a whole food diet have your cholesterol below 150, would you say that that would reduce your risk dramatically to heart disease or not?
DR. STEPHEN SINATRA: I mean yes and no. I mean I've been practicing cardiology for almost four decades and in patients, and I did over 3000 coronary angiograms, and I was amazed. I would see patients with cholesterols of 140, 150, 160, 170, you know, get coronary artery disease. And the other thing too is like a lot of these patients who had obstructions in coronary vessels, they would have like a 20, 30, 40% obstruction, they didn't really have plaque rupture. But when we did angiographies on these patients and when stents came into vogue, and angioplasty, a lot of these patients with coronary disease had clotting of the coronary vessels. So I think the biggest variable in heart disease and the forgotten variable is blood viscosity, the thickness of your blood. I mean I can't tell you how many times we've seen coronary arteries that were normal, totally normal, in patients who had a heart attack because they clotted blood in basically the coronary vasculature. So you know Castelli is right from the point of view that a lower LDL, you're going to have a greater Zeta potential. You're going to have thinner blood but remember a very low HDL. You know HDL in men, let's say levels in their 20s, the reason why they get heart attacks is because they're blood is very thick. So a higher HDL protects you from thicker blood, so to speak. So I've changed my whole focus on coronary disease looking at really the viscosity or the Zeta potential of one's blood.
KIRK HAMILTON: So I'm going to hang out more, then we'll move from cholesterol. So the Tarahumara Indians when they have very low cholesterol totals, they have low HDLs and yet they don't get atherosclerosis. So is it true that the lower your total cholesterol, the HDL is less important or is that, you don't believe that?
DR. STEPHEN SINATRA: Well no, I believe it, but remember the Tarahumara Indians, they're exercising a lot, too, so I mean there's a lot of different variables. And then they're going barefoot, you know. And I have to tell you, in my latest book "Earthing" I mean I think going barefoot or grounding the body, in our research we showed not only does it improve heart rate variability and balance the autonomic nervous system, but it also improves blood viscosity, it increases Zeta potential as well. So I think there's a lot of forces in our environment that are very protective. And an exercising Indian with a low HDL who is basically improving their Zeta potential by exercising and going barefoot, I think is one of the greatest things of improving one's cardiovascular risk because when you do that you're actually improving Zeta potential. And remember the Zeta potential is the force between RBCs, so if the force between your red cells is great, that means they have a less tendency to stick together. And again I believe that sticky blood or hypercoagulable blood is really the root cause of coronary disease as well as degenerative disease and cancer as well.
KIRK HAMILTON: You know I plead ignorance. I've never used the word, or seen the term Zeta potential, so help me out. Explain it in a layman's term again one more time.
DR. STEPHEN SINATRA: The Zeta potential basically is the force of red blood cells in the blood stream. Think of a traffic jam, Kirk. In a traffic jam there's cars that are sort of stuck. You know, they're not moving past one another. So in a traffic jam there can be more congestion. Now think of a - you're on the highway and the cars are flying by at you know 60, 70, 80 miles per hour. Well basically there's a lot of force between those cars. So in the blood stream, the higher the Zeta potential, the greater the velocity between red blood cells. And when you have a higher velocity your blood is more like red wine as opposed to red ketchup. So as a cardiologist I am really looking at Zeta potential as being thee universal risk factor involving the heart. So if you look at all the risk factors, like I mentioned in Framingham, and I don't think Dr. Castelli knew about Zeta potential back then, because I think it's a recent variable. But basically the important thing to consider here is that the thinner your blood the less risk of heart disease and with thinner blood you have a greater Zeta potential.
KIRK HAMILTON: Right. Okay. So the higher the Zeta potential, the better. Can you measure that?
DR. STEPHEN SINATRA: Oh yeah. You can measure it with sophisticated testing. Hopefully someday - there was a company that looked at blood rheology that measured it, but this was Dr. Kinsey's data and basically they spent over 25 million dollars looking at this technology but because of the economy they recently went out of business. But somebody will probably resurrect that technology because it's so good.
KIRK HAMILTON: We are talking to Dr. Stephen Sinatra, author of the book "Reverse Heart Disease," and he is also a cardiologist that is bringing in the New Cardiology and Metabolic Cardiology. So let's talk about statins for a minute and then we'll move from cholesterol. But everybody's exposed to them. Can you educate the layperson on, should he ever get one from his cardiologist? When do you use them, and if you do use them, what agents, nutraceuticals do you do to help protect yourself from the statins?
DR. STEPHEN SINATRA: Yeah sure. I mean I do use statins. I mean the best population for statin use is a male between 50 and 75 years old. I don't like to use statins in the elderly. I've been disappointed with them and basically the way statins work. First of all they're natural cholesterol killers. Now in the process of killing cholesterol, you're knocking out squalene which is very important to the immune system of the body. You're knocking out Co-Q10. So it's important that whenever you use a statin you give the body back coenzyme Q10, because you're knocking out a natural biochemical pathway. But the way statins really work, Kirk, is that not only do they lower cholesterol, which is again a small player in heart disease, but they lower inflammation. They lower C-reactive protein, they support blood viscosity, they make the blood thinner. They change the shape of RBCs. They create less blood RBC aggregation. So basically statins create less blood thinning. And I was just - in my newsletter I was just commenting on a pearl in cardiology. It just came out of the Jupiter study in women. For example, women who had high C-reactive proteins and inflamed blood, they were placed on statin drugs and they had less cardiovascular events and less thromboembolism and less venous stasis in their legs. And again it makes perfect sense because statins are anti-inflammatory agents. So the truth about statins is I use them predominantly in men, and I will use them in women, especially women with metabolic syndrome or obese women or women who have high grade coronary disease. I will use them in that population. But I predominantly use them in men. They have the greatest to gain. Will I ever treat woman with cholesterol of 280 who has just a high cholesterol and maybe a normal HDL? Absolutely not! I think that's bad medicine. I think what doctors in this country have done is they're treating numbers and they're not treating patients. You must treat the patient and not the number, and I think these women who are being treated for high cholesterol, it's a travesty because remember statin drugs do create more breast cancer in women. Just on the basis of Co-Q10 lowering alone, so you gotta be cautious whenever you use a statin.
KIRK HAMILTON: Okay. Let me, because I measure a ton of Co-Q10 levels, because when I give it I want to make sure the stuff gets absorbed. So what dosages do you start out with, and do you try in a cardiovascular patient to get your Co-Q10 levels above 3, or what do you do?
DR. STEPHEN SINATRA: Yes. Actually that question came up at the Co-Q10 conference in 1998. I actually was the first to really suggest that we should use Co-Q10 levels five to seven times normal. I presented three cases at that in Kona conference where I had three cases of refractory heart failure where we pushed Co-Q10 levels greater than 3.5 ug/ml and all three patients did not improve unless their Co-Q10 level was that high. We used to think that we needed to get a level like 2 ½ times normal and I found that we needed to go much higher. So when it comes to severe congestive heart failure I will frequently give Co-Q10 3, 4, 5, 600 mg a day in divided doses trying to get the blood level greater than 3.5 ug/ml. In the two biggest studies, the one that was done in Australia and the one that was done by Gottlieb's group in Maryland, very well done studies, but they were both doomed to fail from the beginning because none of the participants got their blood level greater than 2.5. And in these clinical studies they said Co-Q10 didn't work, but yet they weren't giving a very highly bioavailable form of Co-Q10 and they weren't getting higher blood levels. So when it comes to Co-Q10, just like when we use ACE inhibitors or pharmaceutical agents, we've got to focus on the blood level.
KIRK HAMILTON: Right. And I think the high end normal range is like 1.6 or 1.5 or something, so this looks bizarre when you're doing it if you don't know what you're shooting for. The 3.5 level is up there.
DR. STEPHEN SINATRA: Oh yeah, it's up there. If you figure normal level is 0.8 and you go to 4, I mean you're five times normal so, and that's what I need to see in my refractory patients. But remember Co-Q10 is only one slice of the coin. When I discovered metabolic cardiology, now I use you know I call it the "Awesome Foursome." I call it the combination of Co-Q10, ribose, magnesium, and the carnitines, broad-spectrum carnitines, and I find that I can in really a lot of refractory heart failure in those patients or those patients waiting for heart transplants, by using the metabolic approach.
KIRK HAMILTON: So are those four nutrients, the coenzyme Q10, carnitine, ribose and magnesium, they're for to produce energy in the heart cell essentially, correct?
DR. STEPHEN SINATRA: Yes. Basically what they do is they improve the energy substrate pool. In most patients with heart disease, the essence of heart disease and the reason why I wrote the book "Metabolic Cardiology" is this. In any patient with heart disease, it's like putting change in your pocket and you have a hole in your pocket. You keep putting change in your pocket but you don't have any change. You keep losing it. Well a patient with heart disease, the same thing occurs. These people, whether you have mitral valve prolapse or coronary artery disease or valvular heart disease or cardiomyopathy or diabetic heart or a stent or a bypass, you know whatever the heart disease is, I don't care. What I do care about is with any form of heart disease we get a diminished supply of ATP in the heart, adenosine triphosphate. And when ATP levels drop in heart cells diastolic dysfunction deteriorates, meaning that we have a falling diastolic dysfunction which eventually results in systolic contraction being compromised over time. So when this occurs we have a decrease in energy substrates and the secret to fortifying the heart is like fertilizing your lawn. You have to increase ATP in heart cells, and the only way you can do that is by giving these energy substrates to help to form ATP. So when you give ribose, you know the hexose monophosphate shunt in our body makes ribose to help support ATP production, but our body can't make it back fast enough. If we have an ischemic heart, the Krebs cycle just becomes almost poisoned and we can't form ATP by endogenous production, so we have to help the body out by giving it ribose, Q10, carnitine. See ribose helps to form the ATP molecule. Remember, if you look at ATP there's an adenosine ring, there's a ribose five-sided pentose sugar and three phosphate groups. So ribose is the rate-limiting step. We give ribose to form ATP, we give magnesium, Co-Q10 and carnitine to increase the turn-over ATP in the mitochondria. And when you do that we improve energy substrates, and when you do that, heart function soars and improves and people feel remarkably better. So metabolic cardiology in my mind is really the essence in treating heart disease.
KIRK HAMILTON: So you talked about reasonable dose ranges of Co-Q10 somewhere between 300 and 600 mg. Give us some ball park ranges for carnitine -
DR. STEPHEN SINATRA: Yes, like 1 to 3 grams. Depending on how compromised the heart is. I mean if I have a patient with coronary disease is only taking a statin, I will use 200 mg of Co-Q10 , 100 twice a day . In a healthy person with no heart disease, I will just given them 100 mg of Co-Q10, but in somebody with a compromised heart, the greater the heart failure, the more the carnitine, so I might give 3 grams of carnitine over opposed, to maybe 1 or 1 ½ grams to somebody with coronary artery disease. For magnesium, I will give 400 to 800 mg a day, and I like magnesium citrate, glycinate, orotate. I like magnesium orotate because I learned from the Australians about a decade ago that, or five years ago, that magnesium orotate helps to build ATP substrates. So I like mixed magnesiums, like I like mixed carnitines. I know from my newsletter subscribers I developed these formulas, and mixed carnitines are really good because remember acetyl-L carnitine gets into the brain, propyl-L-carnitine helps to secrete oxide that gets into the heart muscle very quickly. And then there's L-carnitine that is diffused throughout the body. And then you know ribose has a half-life of about 20 minutes, so I like to get ribose with carnitine, Co-Q10 and magnesium altogether.
KIRK HAMILTON: So that's your ATP energy boosters as you describe in the book.
DR. STEPHEN SINATRA: Exactly.
KIRK HAMILTON: Alright.
DR. STEPHEN SINATRA: Exactly. That's my metabolic approach to coronary artery disease as well as heart failure.
KIRK HAMILTON: You mentioned C-reactive protein (CRP) and I want to make sure I get it in here because if you keep someone below 1, what does that mean to you? Is that, you know, in the lab it will say that's low risk to heart disease, and 1 to 3 is moderate risk, and 3 to 10 is high risk. So what does that mean to you? Does that really give you a significant anti-inflammatory benefit if it's below 1?
DR. STEPHEN SINATRA: Yes, well it's a biological marker. Now look, people can be inflamed, and I've seen people with electrosensitivity syndrome who have inflammation from being electrically polluted from cordless phones, cellular phones or computers, but they have normal C-reactive proteins. So a C-reactive protein in the electrosensitive individual is a poor biomarker. However, a C-reactive protein in an inflamed individual from let's say, periodontal disease or coronary artery disease or autoimmune disease or Lyme disease, is a good biological marker. So it's safe to say that if your C-reactive protein is less than 1 you probably don't have inflammation but you could still have electrosensitivity, you know, so it gets a little bit complicated. But in my practice when I see patients I get a high sensitive C-reactive protein and if it's less than 1, you know I rejoice, and I tell these patients with reasonable, reasonable assurance that they don't have chronic inflammation.
KIRK HAMILTON: So let's move to the next popular supplement, fish oils. How do you use them? Do you use them? Do you tell people just to eat fish? And if we reduce the other side of the aisle, the omega-6, the high arachidonic acid containing foods, would - is that more of the problem? So -
DR. STEPHEN SINATRA: Yes, it's a combination. I mean I've been using fish oils for almost two decades now and I like omega-3 essential fatty acids. I like them better from the animal side as opposed to the ALA. Remember it takes 12 times the energy in the body to reduce let's say flax seed oil down to an activated omega-3 into a DHA or an EPA. My favorite forms now of DHA comes from squid oil. I just recently switched to squid oil because the average life of a squid is about 450 days, and I think the problem with fish oils is unless they're using sardines and anchovies, which I've used for years, and my newsletter subscriber clientele are really good because you know you get less toxic metals and you get less PCBs in these smaller fish, but again you're raping the oceans. And in a lot of the fish oils that use omega-3s from wild Alaskan salmon, I mean sometimes these salmon are 6, 7, 8, 10 years old. So I've switched to squid oil because they have a higher combination of DHA, and remember from the cardiovascular point of view DHA is taken up by the heart, the gray matter of the brain, as well as the retina. So from the population that I treat, I treat less of an arthritic population, I use more DHA over EPA. So I've switched to squid oil, but I still use fish oil as well. I mean and now I am using a combination of squid and fish oil to get higher quantities of DHA. I know that sounds complicated but I just believe that fish oil or squid oil or omega-3 essential fatty acids not only do they improve heart rate variability, they prevent plaque rupture, they help thin the blood, they are one of the best ways of improving Zeta potential in the blood. So I just feel from the work that I do in cardiovascular disease it's something that you have to bring to the table.
KIRK HAMILTON: Do you ever use krill oil?
DR. STEPHEN SINATRA: I used to use krill. I like krill, but I am concerned about crustaceans. I am concerned about iodine allergy. I am concerned about you know shellfish allergy. If you've ever seen in it in the cath lab, it will raise your hair. It's quite dramatic. So I never came out with a krill oil product. If some of my subscribers wanted to use it, it's okay, but again I like to protect the crustaceans and I'd rather go with squid because I think it's a better form of oil, a safer form of oil, and they're also harvested by hand by the way. They're caught, and again their lifespan is only 450 days.
KIRK HAMILTON: We're talking to Dr. Stephen Sinatra, cardiologist, and the book he has written is "Reverse Heart Disease Now." I wanted to shift to the diet that you talk about. Your favorite diet. You call it the PAM diet, not to be confused with Pam that comes in a can. Pan-Asian Mediterranean diet. Can you explain that for me and what you - why you think it is so good?
DR. STEPHEN SINATRA: Yeah. I mean if you look at the some of the longevity belts in the world, they're on the Mediterranean basin and Okinawa in Japan. And if you look at these diets, I mean these diets have something in common. They're low glycemic, they use lots of fresh fruits and vegetables, onions and garlic. Asians use more seaweed. They certainly take in a lot of omega-3s. A lot of these cultures don't eat chunks of meat, but they sort of flavor their sauces with meat. So these are the ideal forms of diet. I mean a lot of plant-based foods, you know some animal protein, but again they're anti-inflammatory diets and that's the key. And a lot of these diets don't invoke insulin as much as the modern diets of the United States, Australia, and England so to speak. And we have far greater heart disease in these industrialized countries as opposed to the countries in the Pacific Rim and the Mediterranean basin.
KIRK HAMILTON: Tell me about your thoughts on milk. There's obviously cultures that eat traditional nonprocessed dairy products. I was just looking at the Blue Zone website and one of my favorite book is the "Blue Zone" because he studied four aging populations around the world and he had a DVD on the Ikarians in the Greek Islands, and they eat vegetables, beans, potatoes, olive oil and not a lot of animal food except they do eat goat's milk. So how do you incorporate dairy if you do in your heart-healthy program?
DR. STEPHEN SINATRA: Hey, look, I was in Lancaster, Pennsylvania the other day and I was going near an Amish farm and said unpasteurized milk. And I was ready to drive in and drink a couple of glasses. I mean look when it comes to unpasteurized milk and when you're getting all those enzymes and stuff, it's great. But the problem with milk is when we pasteurize it and homogenize it we're bringing in the XO factor. And basically xanthine oxidase is a small particle, an inflammatory particle in milk and you know I just believe that you know milk when it's pasteurized and homogenized and it takes the bacteria out, you know this can cause inflammation. So we know now in children who have an allergy to milk, milk allergy in a child, can cause cross-react with the pancreas. And we know that type 1 diabetes can be related to milk allergies because there can be destruction of the pancreas, so I am not too bullish on milk. However, goat's milk is okay, sheep's milk is okay . It's just cow's milk that I have a problem with and if it's unpasteurized - like I was in Ireland - I was salmon fishing there about five years ago. I stopped in a farm and they gave me organic milk for my coffee, it was the greatest cup of coffee I ever had, and again, I would drink unpasteurized milk in a heartbeat because of all the healthy enzymes found in the milk. And remember, when it's non homogenized, that whole XO factor is taken out of the equation.
KIRK HAMILTON: One of my frustrating things is that when people are on traditional blood thinning medications, Coumadin, Warfarin, and you know the doc goes and says, well get off all vitamin K rich whatever, and so they tell them to eat a low vegetable based diet. And we know that vitamin K is a - it actually is protective against vascular disease. How do you approach that? I've always said, this is what I've said. I've said, listen, you can adjust your Coumadin to your diet and so I tell them to eat lots of vegetables but keep it consistent and then they have to adjust the medication up. How do you approach that?
DR. STEPHEN SINATRA: I actually - I do it the way you did it. As a cardiologist, I recognize that Coumadin is a vitamin K antagonist and we need vitamin K1 for the integrity of our blood vessels. And actually we need more vitamin K2 over K1, but K1 is important. So I do not foster the belief that you should omit vitamin K in your diets. So I would tell my patients, look if you want to have green leafy vegetables you can. You know you can certainly have it you know up to three to four times a week. I don't want you to eat them every day if you're on Coumadin, but don't omit it from the diet at the same time. You got to be moderate with this. So I'm a big believer in vitamin K protecting you from coronary disease. And I can't tell you how many echocardiograms I've seen in young people who have calcification of the mitral valve apparatus due to long-standing Coumadin. So if I can get my patients off Coumadin I do it, but remember, you know Coumadin is going to prevent strokes in patients with atrial fibrillation if they have mitral regurgitation. If they have a prosthetic valve you must take Coumadin. If you have a pacemaker with a leaking mitral valve you must take Coumadin. So I wear an integrative hat here and I bring more conventional medicine to the table. I am bullish on Coumadin, but I am also bullish on vitamin K at the same time.
KIRK HAMILTON: So talk about vitamin K from natto or vitamin K2. Can you describe the difference to me?
DR. STEPHEN SINATRA: Yeah. These are extra hepatic. Vitamin K1 has to do with the hematological system. It's also involved in blood vessel support, but not as much as vitamin K2. Vitamin K2 is extra hepatic and basically it's found in strong bones. You know, one of the best treatments for osteoporosis in women is vitamin K2. It builds strong bones. And remember vitamin K2 takes calcium out of blood vessels where it doesn't belong and puts it back in bones where it does belong. And the way I got interested in this is my wife had a parathyroid tumor. She had severe osteoporosis and when I looked at the literature on osteoporosis everybody was doing the same thing, vitamin D, magnesium, boron, calcium and all the same stuff . But when I looked at an epidemiological study from Japan, and I saw that when Hiroshima women ate less natto than Tokyo women. Tokyo women ate the most natto in the world and Great Britain women did not eat natto at all. And when it came to bone fractures and osteoporosis, women living in Tokyo had the least amount in the world, Hiroshima was second, and Great Britain was a dismal, dismal third. And what people really need to know about is how vitamin K2 protects against osteoporosis by building strong bones and also taking calcium out of bone. And one of the reasons why we have such calcification in our vascular system is basically due to poor amounts of vitamin K2 in the body. I am a big proponent of taking vitamin K2 not only as a supplement, but by eating natto and cheeses that contain vitamin K2 as well.
KIRK HAMILTON: Let's talk about for a second irregular heart beats. And if I'm correct with my facts, atrial fibrillation is the most common irregular heart beat in the elderly. Is that correct?
DR. STEPHEN SINATRA: Well yeah. I mean PVCs and PACs are more common, but yeah atrial fibrillation is a big factor. I see it all the time. It's becoming more and more prevalent in the population, and again I think it's the environment that's - the toxic environment that's causing more atrial fibrillation.
KIRK HAMILTON: So what approach do you do? Is it the big four? Like we've given magnesium before IV and it will occasionally knock out some a-fib. So what is your metabolic approach to atrial fibrillation?
DR. STEPHEN SINATRA: Yeah, I mean first of all when they're in fib, the best patient to try that on is if they go in and out of a-fib. So when they're in a-fib it's hard to convert them, but sometimes these patients or many times they convert spontaneously. And when they do that what I'll do is I'll add fish oil to the mix because fish oils have a great impact on heart rate variability. I will ground these patients because when you ground their feet to the earth you're sucking up electrons and you're making more electrons available for ATP support. You're also balancing the autonomic nervous system. I will certainly give the "awesome foursome" for energy substrate support because whenever you bring ATP to the mix you know you're getting the cardiomyocytes to function better. So my sort of antidote for atrial fibrillation is the combination of grounding, fish oil and bring metabolic cardiology to the table. Because if I can keep these people in sinus rhythm more, well then I've done my job by keeping them more in sinus rhythm and less in atrial fibrillation which is basically you don't want that. I mean these people, especially the elderly, a lot of them fall apart because they lose about 20 to 30% of their cardiac output when they go into atrial fibrillation. A lot of them feel fatigued, and feel like they have the flu and they get short of breath. So the more times I keep them in sinus rhythm the better clinical response I get.
KIRK HAMILTON: Do you think foods can trigger an arrhythmia?
DR. STEPHEN SINATRA: Sure. I mean look at migraine. I mean migraine can be triggered by foods all the time. Nitrate-producing food, nitrites, food colorings, certainly. I think high fructose corn syrup can trigger adrenaline-like responses, especially if it's cut with you know high dose heavy metals. I mean yeah I'm a big proponent on food allergy, whether it's dyes in foods or you know synthetics in foods. I mean certainly if you look at psoriasis and gluten-free patterns and gluten-free foods, you know I'm really bullish on that in patients with multiple sclerosis and psoriasis. So I just feel it's carefully selecting foods in any medical condition is important. And arrhythmia, is actually huge when it comes to arrhythmia, as well.
KIRK HAMILTON: Let's talk about a kind of controversial topic, and toxicity in the heart and heart disease, and we know that there's a study about elevated levels - I think it was mercury in the tissue of the heart. And you know several tens of thousands times and a few other metals - and that brings up you know the whole thing of chelation. Are you an oral chelation person, IV chelation person, or nothing chelation person?
DR. STEPHEN SINATRA: Well, um, back in let me see - I think it was probably around 1990. I kept the American Heart Association in Hartford, Connecticut neutral on chelation. I was on their board of directors there, I think I was chairman. I can't remember. But I did have a guy that had horrendous coronary disease and the surgeons couldn't bypass him, and he went out and he got about 150 chelation IV treatments. And when I recathed him and I sent the data down to a guy in California. He had improvement in his vasculature. In other words, he had less coronary vascular disease. So that one case made an impact on me. I never did chelation in the office, I never did IV chelation myself. I do recommend P.O. chelation. I do like vitamin K2 as an oral chelator, and I recommend like 300 micrograms a day in patients with coronary disease for at least a period of three years. I am doing a small clinical evaluation with EBCT scans and looking at calcification. And I did have one woman who had reversal of her calcified pattern in one coronary artery so far. So as far as oral chelation goes, I like it. If my patients get IV chelation you know I won't obstruct them from it. It's a lot more expense, a lot more time, but if they want to do it I will support their intentions.
KIRK HAMILTON: Then do you believe in heavy metal toxicity of the heart muscle or for that matter any part of the body or not?
DR. STEPHEN SINATRA: Oh absolutely. Yeah, I mean the problem is we're all heavy metal toxic. It's everywhere. The burning of coal in China is horrendous in the world right now. And when coal burns in the atmosphere and it rains, it forms methyl mercury and algae attaches to methyl mercury and small fish eat the algae and then bigger fish eat smaller fish and so I'm a big proponent of eating healthy fish. So I tell my newsletter subscribers not to eat tuna, swordfish, tile fish, shark, rugby fish. You know, even Pacific halibut and Atlantic grouper. But as far as smaller fish goes, like mackerel or smaller halibut from the Atlantic seacoast, migratory salmon, sardines, probably the healthiest fish of all, and anchovies, I will tell my patients to eat smaller fish because I'm really worried about heavy metal toxicity.
KIRK HAMILTON: Let's talk about dentists and oral physicians that see the mouth and we've all heard the connection between the mouth and heart disease. Can you explain that, if you believe in it, and what you think about it.
DR. STEPHEN SINATRA: Yeah. I just looked at an article today about brushing the teeth twice a day prevents inflammation and coronary disease. And I remember reading a cath study years ago showing that patients with more periodontal disease get more coronary disease and that was my experience when I was doing cardiac cath myself. So the mouth is, like a lot of people say, the eyes are the windows of the soul, well the mouth is the window of the heart. So when I see a healthy mouth in somebody you know I suspect I'm going to find a healthy heart. Remember, periodontal disease will trigger inflammation, which triggers C-reactive protein and C-reactive protein is an inflammatory mediator, will increase further inflammation in blood vessels so it makes perfect sense to have good dental hygiene.
KIRK HAMILTON: Alright. Well let's talk about another area that you have a certification in, bioenergetic psychotherapy. Did I say that correctly?
DR. STEPHEN SINATRA: Correct, yeah.
KIRK HAMILTON: We've talked about a lot of metabolic things. Let's talk about stress in the heart. How do you approach that?
DR. STEPHEN SINATRA: Well I mean that's a big factor. I mean I believe stress is the biggest single factor in increasing the thickness of the blood. Remember, when you're under stress you're going to put out cortisol, you're going to put out epinephrine, you're going to put out adrenaline, you're going to lower potassium, and potassium is one of the best things to protect you from thickened blood. There was a nice study done in Harvard for example years ago where Harvard alumni who ate the most potassium in a diet had less stroke. They didn't comment on blood viscosity but clearly, clearly the more potassium you take in the diet the thinner your blood. Again, it comes back to what we first talked about in the interview. Blood viscosity in my mind is the single-most important parameter in cardiovascular disease. So I'm such a big proponent on thinning the blood. So anything that will thin the blood, in my opinion, is just the most important thing. So, when you're under stress your blood thickens. It coagulates. And when I wrote the book "Heartbreak and Heart Disease" I had many a patient who had normal coronary arteries who had clots being pulled out of their heart because they did not obstruct because of coronary obstructive disease; they obstructed their blood vessels because they're under overwhelming stress and their blood clotted in their coronary vasculature. So when it comes to emotional stress it has hormonal and metabolic and electrolyte interactions which are really deleterious to the cardiovascular system. So one of the reasons why I became a bioenergetic therapist was I realized that treating the heart is not from the neck down but from the neck up.
KIRK HAMILTON: So what are some techniques that you do to help people with stress? I mean we all live with it pretty intensely in this society.
DR. STEPHEN SINATRA: Well suppressed emotion is probably the worst thing for the heart, so the best way of healing the heart is to get in touch with your emotions and to make your emotions not a lie, so to speak. So I'll give you a classic example. My patients who say, gee I went to a movie the other night and it made me cry. I would say, well look, I said you know the movie didn't make you cry, it just touched your sadness. And you know people who don't get in touch with their sadness, or people who refuse to cry, I believe is a major coronary risk factor. So I think one of the best ways of alleviating emotional stress is to get into your sadness and to just cry and let it all hang out and let your emotions out. I do the same thing with anger and not, you know, having anger out is healthy, but not rage. Rage is uncontrollable anger and in rage you could hurt yourself or others. So but we use techniques in bioenergetics to get people to cry and get people to have their anger, and we ground them at the same time and we get them in touch with the earth. So having your feelings is the most important thing. And while I'm on that, it's not so much that in answer to your question, you know I shouldn't be sad, I shouldn't be angry, I shouldn't feel shame right now, you know I shouldn't feel jealous, but to have those emotions and don't editorialize on why you're sad but just have the sadness. And I'll tell you one thing more, Kirk, back in 1982 I published in Connecticut Medicine a study we did at our hospital in Manchester, Connecticut where we measured cortisol and epinephrine in the urine, breakdown products of stress hormones. And what we did in this hospital environment. We took 44 people and we found that women who had their emotions out, who hugged with one another and networked with one another and cried and got angry with one another, and when we broke the codes they had very little stress hormones in their urine and none of them had coronary disease. But when I looked at the men who were like lumps of clay and they didn't cry, they didn't get angry, we asked them how you felt, they felt fine. Their urine told the truth. They had enormous quantities of cortisol and epinephrine breakdown products in the urine and when we broke their codes, 80% of them had coronary disease. So back in 1982 I got the message that men who don't cry get heart disease. And that's why I ended up going into a 10 year training program in psychotherapy.
KIRK HAMILTON: Very good. Well a couple more technical things and then I want to close up here. Talk to me about hormones and heart disease. Is testosterone cardioprotective in males or -
DR. STEPHEN SINATRA: Absolutely. Oh yeah. I mean you know low testosterone is a coronary risk factor because there's lots of testosterone receptors in the heart. So you know would I give a patient testosterone if they had metabolic syndrome and low testosterone? Yeah, absolutely. Now remember, testosterone can be a double-edged sword, though. I mean, you want to be careful because testosterone can cause polycythemia. It can cause increased RBCs in the blood. So whenever a patient is taking testosterone whether we're treating depression or whether we're treating muscle wasting or libido or whatever, it makes sense to check their hematocrits at the same time. So I would always tell the anti-aging doctors when I would lecture at the A4M, for example, it's okay to use testosterone but remember to check their hematocrit because one of the side reactions of testosterone is secondary polycythemia. So we want to be careful and monitor testosterone carefully in men.
KIRK HAMILTON: How about - this is pretty basic and I'm a big exercise freak. Tell me about exercise in cardiovascular disease prevention and treatment.
DR. STEPHEN SINATRA: Mild to moderate exercise is good. Marathon running is bad. You know it depends on the exercise. I'm not a big fan of racquetball. It's start-stop. I'm also not a big fan of interval training. I know there's been a lot of research on it lately but interval training is great for a Marine, it's great for you know a young person, but it's not good for somebody like my age. Because if you do interval training it's like racquetball, you're starting up quickly, you're stopping down, you're springing, you're walking. These start-stop situations in vulnerable people could cause plaque rupture. So one of the greatest advantages of exercise is that, you know if your car does break down and you push your car or if you refrigerator goes off and you try to lift up your refrigerator and if you're conditioned you're not going to get plaque rupture. But if you're unconditioned, and I saw MIs in many unconditioned men who were called upon to perform an activity that they weren't used to that developed plaque rupture. Anger in an unfit male - anger is an Achilles heel because anger can cause plaque rupture. But the more fit you are, the better you are. Now I've had men in my practice try to run off their anger and they start running and jogging and sprinting and I've had two or three MIs in that population. So it's not a good idea to run off your anger. It's just a good idea to walk and dance and participate in moderate exercise. The reason why I don't like marathon running is it has too much oxidative stress in the body. There's so much oxidative stress that occurs in marathon running that you know I do believe in severe endothelial cell dysfunction. Even if you protect yourself with antioxidants during the course of 26 miles.
KIRK HAMILTON: Here's an area where it's always tough for me. I wanted to evaluate somebody for blood vessel disease and there are a myriad of tests from angiography to SPECT test scanning on treadmills to calcium scores. You know you're a primary care physician, I got a C-reactive protein that's low, I want to give a little more reassurance to the patient. What do you recommend?
DR. STEPHEN SINATRA: You know an IMT is a nice test. That's intimal medial thickness of the carotid. It can be done by ultrasound. I was doing it five years ago in my office. I think it's going to become more sophisticated in the future where I used to send my readings out to California to get read. So I think an office ultrasound looking at the carotids because it's so easy. It's like a quarter of inch below your skin. I think the IMT is going to give the greatest amount of information and be the most cost effective. I do like an EBCT scan of the coronaries. You do get radiation, but it will tell you if you have calcification, if you're high risk. You can get a 64-slice CT, which is more radiation, but you know it's dye in the brachial artery. Certainly nuclear studies I like. You will get radiation with those. I mean there's a lot of good noninvasive tests you can do. I mean an exercise echo is a very easy test to do. It can give you an enormous amount of information, particularly in a woman if she has pendulous breasts where a thallium scan can be sort of uneventful because of false-positives or false-negatives. So I mean there's a lot of noninvasive tests you can do. But I think the IMT has the most promise so I think that's the horse I would bet in the future and it's coming right now.
KIRK HAMILTON: So is heart disease preventable and reversible? So preventable one, reversible two.
DR. STEPHEN SINATRA: Oh yeah. I mean I think it's very preventable. I think you know to prevent heart disease, I bring in my six pillars of healing. A non-inflammatory diet. We talked about a plant-based diet is number one. Number two would be certainly exercise, mild to moderate exercise. And remember exercise is going to increase to growth hormone. It's also going to help detoxify whenever you sweat or whenever you help, you know, move toxic waste products out of the bowels, and exercise will do that you know. One of the best ways of alleviating constipation in my elderly population was to, I would tell them to play doubles tennis. I would tell them to walk more, walk the dog, things like that. Certainly detoxification you got to bring to the table. I'm a big proponent far infrared saunas for mercury detox and heavy metal detox, as well as insecticide and pesticide. You've got to bring supplements to the table. I call that my fourth pillar of healing. I mean certainly the "awesome foursome", the metabolic cardiology approach. We talked about carotenoids and flavonoids. Fish oil is a supplement, it's a must-have for anybody with coronary disease. The mind-body, or my fifth pillar of healing is equally as important. We must practice mind-body medicine. We need to assuage the sympathetic nervous system. Everybody has heightened sympathetic tone today, so Qigong, yoga, meditation, certainly avoidance of sympathomimetics like beta agonists, short acting calcium blockers, some of the alpha blockers for the prostate. I worry about those because they can trigger the autonomic nervous system. The beta blockers are good here, the ACE inhibitors are good here. Fish oil will support heart rate variability and have a profound effect on the autonomic nervous system. And my sixth pillar of healing - I would add prayer to that list as well, positive intentions. Oh my gosh, that's the biggest thing in health, particularly cardiovascular disease. Always think positively. You know, think your cup is being half full as opposed to half empty. Positive intention is half the battle in illness. And my sixth pillar of healing is grounding. Our research on grounding, and the latest book I wrote is "Earthing: The Greatest Health Discovery Ever." I can tell you what we found in our experiments on grounding is that not only does it support the autonomic nervous system like I mentioned, it supports heart rate variability, it improves heart rate variability, it also improves Zeta potential and it thins the blood. So and when you walk barefoot and you soak up all these electrons from the earth, basically you're giving your body more electrons to combat the free radical positive. See we have positive charges in our body current from free radicals. They are positively charged so if you soak up more electrons from your feet, whether you go on a sandy beach or barefoot in the park or walking on concrete or your basement floor for that matter. When you're soaking up these electrons not only are you neutralizing positively charged free radicals in the body, but you're also making, you're having more electrons that are available for ATP synthesis, so you can bring more metabolic cardiology to the table. So yeah, heart disease is preventable. We want to avoid metabolic syndrome at all costs. We don't want to gain weight. We don't want to eat sugars. And is it reversible? Absolutely. I mean I just believe that - my last newsletter article is on reproducing stem cells in the heart naturally. And there was an article by Swedish investigators in science in April 2009 which showed that you can replace stem cells in the heart maybe four times in a lifetime. It's kind of incredible data and they did this with carbon 14 testing. But so supposedly you've got an ejection fraction of 15% and you live 10 years on metabolic cardiology and all of a sudden your ejection fraction now goes to 25 to 35%. What I believe is happening is that if you can increase ATP in a compromised myocardium you allow stem cell function to improve. And when you do that you're regenerating the heart so I feel that heart disease, whether it's coronary disease or muscle wasting disease or cardiomyopathy, is totally reversible and the science is there.
KIRK HAMILTON: We'll have to stop there, Dr. Sinatra. I want to thank you so much. I think we got most of the questions. We did a pretty good job in an hour.
DR. STEPHEN SINATRA: Oh, so we did an hour, huh?
KIRK HAMILTON: Yeah, we did an hour.
DR. STEPHEN SINATRA: Kirk, you did a lot of damage in an hour so that was great, and then let me know when you're going to do some more on this and I'll be happy to talk to you.
KIRK HAMILTON: We'd greatly appreciate it. Thank you so much for your time, Dr. Sinatra.
DR. STEPHEN SINATRA: I will see you.
KIRK HAMILTON: And I want to thank you, the audience, for listening to this edition of Staying Health Today Radio. And until next time, Stay and Be Well.
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